Immunoncology is an innovative therapeutic tool that adds up to the traditional weapons currently used for cancer treatment, such as chemotherapy, radiation therapy, surgery, hormone therapy and biological therapy.
The goal of immuno-oncology is to fight cancer by stimulating the immune system, our body’s natural defense system.
Immune system cells usually activate against anything they recognize as “foreign”, for example infected cells and tumor cells, with the purpose of expelling or destroying them. However, in the case of tumors, the cells gone wild use a number of tricks to bypass the immune system’s control system and proliferate uncontrollably.
Cancer immunotherapy has demonstrated to block this tumor cell self-masking mechanism, so that the immune system is no longer cheated and can resume its fight against the tumor.
The treatment of several types of cancer, such as melanoma, lung cancer or kidney cancer using immunotherapy drugs shows both a reduction in tumor mass and an increase in survival, with results that are often better than those obtained with traditional therapies, such as chemotherapy.
Since the molecules used in immuno-oncology do not act on tumor cells directly but stimulate the immune system’s defense mechanisms, their benefit may become apparent after a longer time period than with other therapies: in certain cases, 16-20 weeks may be required before a response is observed.
With immunotherapy, it is not uncommon to note an initial growth of tumor mass, which is then followed by tumor regression. However, once tumor regression has occurred, a mechanism called immunological memory ensures that a number of immune responses and certain forms of disease stability continue for a long time, with a positive impact on patient survival.
While traditional cancer therapies can induce the selection of drug-resistant tumor cells over time, this is not observed with immuno-oncology because it is not targeted to tumor cells but to the immune system.
Even the side effects of immunotherapy show major differences as compared to those of other cancer therapies, such as chemotherapy, that are often associated with nausea, vomiting, hair loss, infections and neuropathies.
Since immunotherapy has the purpose to boost immune response, it may increase the defense mechanism in other body areas, e.g. causing temporary inflammation of the gastrointestinal tract or the skin.
In most cases, the side effects of immunotherapy drugs are of mild to moderate severity, although more severe reactions may occur. Gastrointestinal or skin disorders can be easily managed by physicians using specific therapeutic measures. In such cases, as in other circumstances, a direct relationship between patients and their doctors is essential to manage toxicities and implement the most appropriate treatment.
Generally speaking, there are no absolute contraindications to immunotherapy. However, additional precautions may be required in patients with pre-existing auto-immune diseases, such as rheumatoid arthritis, Crohn’s disease or psoriasis.
In any case, the decision to suggest immunotherapy should be made by the physician following a careful case-by-case evaluation.
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